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Surgery
Critical Care
Oncology
Radiology
Behavior
24/7 Emergency Service
Internal Medicine
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Cardiology
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Outpatient ultrasound request
Patient Name
Client Name
Species
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canine
feline
Sex
select one
spayed female
neutered male
intact female
spayed female
Breed
Age/DOB
Referring Veterinarian
Referring Practice
Best Contact Number
Presenting Complaint
Pertinent Medical History and PE/ Clinical Pathology Findings
Specific Questions for the Radiologist
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